LETTER TO THE EDITOR
Use of praziquantel in populations at risk of neurocysticercosis
After our original communication5, two further instances of seizures following praziquantel administration during the treatment of intestinal teniasis, became known to the authors (ORIHUELA A., and PLATA O., personal communications). Dr. Orihuela's case, a 39 year-old male with an intestinal infection by T. saginata, had previously received a well tolerated, but unsuccessful, 400 mg/day course of albendazole during 3 days, on account of which, he was later given 50 mg/kg/day of PZQ. On the second day of therapy, he experienced several episodes of secondarily generalized right partial seizures. The other patient corresponded to a 45 year-old female that received a single 20 mg/kg dose of PZQ because of an intestinal hymenolepiasis. Several hours later, she experienced an episode of partial seizure, secondarily generalized. Brain CAT scans in both patients revealed characteristic hypodense cystic lesions of an until then asymptomatic, parenchymal neurocysticercosis, which responded to conventional 15 mg/kg/day courses of albendazole during two weeks1.
Praziquantel is an acylated isoquinole-pyrazine derivative with broad antiparasitic spectrum, used worldwide in both the treatment and control of schistosomiasis6, as well as in other trematodes and most cestode infections4. Contrary to oxamniquine, another antiparasitic currently utilized in mass chemotherapy programs for the control of schistosomiasis, which is known to cause transient EEG and occasional seizures2, praziquantel is devoid of intrinsic neurological toxicity3. The two additional cases of praziquantel-associated seizures, mentioned herein, clearly reinforce our initial suggestion that the compound must
be administered with caution in those areas where cysticercosis is known to occur. Furthermore, the onset of seizures or other related neurological symptoms in an otherwise healthy individual receiving praziquantel, must prompt exhaustive clinical and laboratory evaluations, including the performance of a CAT scan, in order to rule out brain parenchymal cysticercosis.
Jaime R. TORRES R.
Instituto de Medicina Tropical,
Universidad Central de Venezuela,
Apartado 2109, Caracas, Venezuela
Recebido para publicação em 1/6/1989
- 1. ESCOBEDO, F.; PENAGOS, P. & RODRIGUEZ, J. - Albendazole therapy for neurocysticercosis. Arch, intern. Med., 147:738-741, 1987.
- 2. KRAYDEN, S.; KEYSTONE, J. & GLENN, C. - Safety and toxicity of oxamniquine in the treatment of Schistosoma mansoni infections, with particular reference to electroencephalographic abnormalities. Amer. J. trop. Med. Hyg., 32:1344-1346, 1983.
- 3. LEOPOLD, G.; BUMRING, K.; DIEKMAN, H.; STEINER, K. & GRABE, A. - Clinical pharmacology in normal volunteers of praziquantel, a new drug against schistosomes and cestodes. Europ. J. clin. Pharmacol., 14:281-291, 1978.
- 4. REZENDE, G. - Praziquantel: experiência clínica mundial. Boi. chil. Parasit., 38: 52-63, 1983.
- 5. TORRES, J. R.; NOYA, O.; NOYA, B. & MONDOL-Fl, A. - Seizures and praziquantel. A case report. Rev. Inst. Med. trop. S. Paulo, 30:433-436, 1988.
- 6. YOGORE, M.; LEWERT, R. & BLAS, B. - Seroepidemiology of Schistosoma japonicum by ELISA. III. Selective mass chemotherapy with praziquantel in a control program. Amer. J. trop. Med. Hyg., 35:882-890, 1984.
Publication in this collection
14 Oct 2011
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